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Validity of the VERA visual skills screening

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Abstract

Purpose

Most school vision screenings test only visual acuity. There is a need for a valid, easily administered test that screens for a wider variety of learning-related vision problems. Visual Efficiency RAting (VERA) is a software program designed for schools to detect both routine vision problems and visual skill problems. The purpose of this study was to compare the VERA visual skills screening with the optometric assessment of binocular, accommodative, and ocular motor skills.

Methods

One hundred fifty-four children from grades 3 through 5 were evaluated using the VERA visual skills screening, a clinical battery of visual skills testing, the Convergence Insufficiency Symptom Survey, and 2 reading tests.

Results

The sensitivity of VERA in detecting visual skills problems was 45%, and the specificity was 83%. Sensitivity increased to 64% and specificity to 100% in smaller groups of children when overlays of symptoms, classroom behaviors, and reading skills were included.

Conclusions

VERA has fairly good sensitivity and very good specificity in detecting visual skills problems. Given that the majority of visual skill deficits currently go undetected, VERA can be considered a reasonably effective method of in-school visual skills screening.

Section snippets

Methods

Six elementary schools were recruited to participate in the study (4 suburban public schools and 2 urban private schools). Major inclusion criteria included children from grades 3 through 5, 20/25 or better distance visual acuity in each eye, passing a hyperopia screening test (20/30 or worse with +1.50 lenses), and 500” of arc on random dot stereopsis testing. One hundred fifty-four children were tested, with an age range from 8 to 12. The number of subjects tested at each school ranged from

Results

A pilot study in 2005 (unpublished data) with 85 subjects was used to set cut points for pass, fail, and borderline based on the cumulative percentile score of the VERA. Based on the pilot study, a VERA percentile score of 23 or less was considered a “failure” (i.e., indicative of visual skills problems). Classifications of borderline (percentile greater than 23 and less than 62) and pass (percentile greater than or equal to 62) were combined for analysis. For the clinical skills testing, pass

Discussion

A vision screening needs to be simple, fast, valid, and effective,6, 41 as well as safe and acceptable.43 The most important initial consideration is the validity of the screening; validity is assessed through sensitivity and specificity.41 In this study, sensitivity is the percentage of children with visual skill problems that are correctly detected by VERA (true-positives or correct referrals). Sensitivity was fair at only 45%, but increased to 56% and 64% in smaller groups of children with

Conclusion

There is a need for a valid, easily administered school vision screening protocol that detects visual skill problems that interfere with reading and school performance. The VERA visual skills screener has fair sensitivity for detecting visual skills problems. When combined with a symptom survey, reading level, and a classroom behavior survey, sensitivity improves. Specificity of the screening is very good. The ease of administration and the ability of the screening to be utilized without

Acknowledgments

The authors thank Deborah Killion, Laura Satkofsky, Richard Claiborne, and Nanette Cooperman for help with data collection and Marian Weber for library assistance. The authors also thank the children and staff of the 6 schools for their invaluable and enthusiastic participation in the study.

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